Allergic Rhinitis GUIDELINES Pocket Guide

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Allergic Rhinitis GUIDELINES Pocket Guide is based on the latest guidelines of the American Academy of Otolaryngology – Head and Neck Surgery and was developed with their collaboration. This practical quick-reference tool contains key points; detailed evaluation recommendations; extensive and drug tables including specific indications, contraindications, approved ages, dosing, side effects and OTC vs. Rx; evidence-graded key action statements (guidelines); and environmental control measures.

Spiral Bound

14 pages

80# Diamond Silk Cover with Satin Aqueous Coating

4.25″ x 7.25″

Key Points

Definitions

Tables

Key Action Statements

History and Physical Findings

IgE-Specific Tests

Environmental Control Measures

Intranasal Steroids

Oral Antihistamines

Intranasal Antihistamines

Medications Recommendations

Comparison of SLIT and SCIT

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) is the world's largest organization representing specialists who treat the ear, nose, throat, and related structures of the head and neck. The Academy represents approximately 12,000 otolaryngologist-head and neck surgeons who diagnose and treat disorders of those areas. The medical disorders treated by our physicians are among the most common that afflict all Americans, young and old. They include chronic ear infection, sinusitis, snoring and sleep apnea, hearing loss, allergies and hay fever, swallowing disorders, nosebleeds, hoarseness, dizziness, and head and neck cancer.

Allergic Rhinitis GUIDELINES Pocket Guide

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Allergic Rhinitis GUIDELINES Pocket Guide

Key Points

Allergic rhinitis (AR) is one of the most common diseases affecting adults. In the United States today it is the most common chronic disease in children and the fifth most common disease overall.

AR is estimated to affect nearly one in every six Americans and generates $2 to $5 billion dollars in direct health expenditures annually.

Many diagnostic tests and treatments are used in managing patients with this disorder, yet there is considerable variation in their use.

Definitions

AR is defined as an immunoglobulin E (IgE)-mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens. Symptoms include rhinorrhea (anterior or postnasal drip), nasal congestion, nasal itching, and sneezing. AR can be seasonal, perennial, or episodic with symptoms being intermittent or persistent.

AR may be classified by

the temporal pattern of exposure to a triggering allergen as:

seasonal, (e.g., pollens) or

perennial/year round, (e.g., dust mites) or

episodic (environmental from exposures not normally encountered in the patient’s environment, e.g., visiting a home with pets)

frequency of symptoms

intermittent (<4 days/week or <4 weeks/year) or

persistent (>4 days/week and >4 weeks/year)

Note: This classification of symptom frequency has limitations. For example, the patient who has symptoms 3 days/week year round would be classified as “intermittent” even though he or she would more closely resemble a “persistent” patient. It may be best for the patient and the provider to determine which frequency category is most appropriate and would best guide the treatment plan. Based on these definitions, it is possible that a patient may have intermittent symptoms with perennial AR or persistent symptoms with seasonal AR.

severity of symptoms

mild (when symptoms are present but are not interfering with quality of life) or

more severe (when symptoms are bad enough to interfere with quality of life)

Although the FDA uses "seasonal" or "perennial" when approving new medications for AR, classifying a patient’s symptoms by frequency and severity allows for more appropriate treatment selection.

An IgE-mediated inflammatory response to seasonal aeroallergens. The length of seasonal exposure to these allergens is dependent on geographic location and climatic conditions.

Perennial allergic rhinitis (PAR)

An IgE-mediated inflammatory response to year-round environmental aeroallergens. These may include dust mites, mold, animal allergens, or certain occupational allergens.

Intermittent allergic rhinitis

An IgE-mediated inflammatory response and is characterized by frequency of exposure or symptoms (<4 days/week or <4 weeks/year).

Persistent allergic rhinitis

An IgE-mediated inflammatory response and is characterized by persistent symptoms (>4 days/week and >4 weeks/year).

Episodic allergic rhinitis

An IgE-mediated inflammatory response and can occur if an individual is in contact with an exposure that is not normally a part of the individual’s environment (i.e., a cat at a friend’s house).

Table 2. Summary of Guideline Key Action Statements (KAS)

Statement

Action

Strength

1. Patient History and Physical Examination

Clinicians should make the clinical diagnosis of AR when patients present with a history and physical exam consistent with an allergic cause and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. Findings of AR consistent with an allergic cause include, but are not limited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, red and watery eyes.

Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy.

Clinicians may advise avoidance of known allergens or may advise environmental controls (i.e., removal of pets, the use of air filtration systems, bed covers, and acaricides [chemical agents that kill dust mites]) in AR patients who have identified allergens that correlate with clinical symptoms.

Clinicians should assess and document in the medical record patients with a clinical diagnosis of AR for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis and otitis media.

Clinicians should offer, or refer to a clinician who can offer, immunotherapy (sublingual or subcutaneous) for patients with AR who have inadequate response to symptoms with pharmacologic therapy with or without environmental controls.

Clinicians may offer, or refer to a surgeon who can offer, inferior turbinate reduction for patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.

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